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Blue & You - Summer 2010

HEALTH INSURANCE REFORM ANSWERS; Good news for graduates! Arkansas Blue Cross extends health insurance coverage; Need more information before visiting a specialist? We can help!; Redesigned PHS wins top scores in national review

HEALTH INSURANCE REFORM ANSWERS;
Good news for graduates! Arkansas Blue Cross extends health insurance coverage;
Need more information before visiting a specialist? We can help!;
Redesigned PHS wins top scores in national review

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<strong>Summer</strong> 10<br />

A publication for the policyholders of the<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />

family of companies<br />

HEALTH<br />

INSURANCE<br />

REFORM<br />

ANSWERS


6 Good news for graduates!<br />

12 Need more information before visiting<br />

a specialist? We can help!<br />

19 Redesigned PHS wins top scores<br />

in national review<br />

Cal Kellogg, Ph.D., explains<br />

what you need to know about<br />

health insurance reform.<br />

on Page 8<br />

INSIDE<br />

3 Out of the <strong>Blue</strong><br />

4 Health Insurance Reform & <strong>You</strong><br />

6 Good news for graduates! Arkansas <strong>Blue</strong> Cross<br />

extends health insurance coverage<br />

8 <strong>You</strong>r health insurance, your health care, your future<br />

12 Need more information before visiting a<br />

specialist? We can help!<br />

Lose weight The Healthy Weigh!<br />

13 Chronic job stress and your waistline<br />

How much exercise do women really need?<br />

16 Lifelong Health with Dr. David<br />

18 Warning issued for “baby slings”<br />

Can breastfeeding save lives?<br />

19 Redesigned PHS wins top scores in national review<br />

Food for thought: certain foods may keep<br />

aging brains healthy<br />

20 From the Pharmacist — What’s in a drug name and<br />

why did mine change?<br />

21 The Doctor’s Corner<br />

22 Financial Information Privacy Notice<br />

23 Good for your community<br />

Customer Service telephone numbers<br />

24 Good for you<br />

<strong>Summer</strong> 10<br />

is published four times a year by<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield for<br />

the company’s members, health care<br />

professionals and other persons<br />

interested in health care and wellness.<br />

Editor: Kelly Whitehorn — BN<strong>You</strong>-Ed@arkbluecross.com<br />

Assistant Editor: Jennifer Gordon<br />

Designer: Gio Bruno Photographer: Chip Bayer<br />

Contributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming,<br />

Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark<br />

Morehead<br />

Vice President, Communications and Product Development: Karen Raley


Out of the<br />

<strong>Blue</strong><br />

A message from our<br />

CEO and President,<br />

Mark White<br />

The enactment of new health insurance reform legislation<br />

has left many of our valued customers confused<br />

and unsure of how the new law will affect them. We<br />

are hearing questions concerning the changes that can<br />

be expected as various provisions of the new law take<br />

effect from employers, individuals and families, as well<br />

as agents who market our products. And the confusion<br />

is certainly understandable as the law is far-reaching<br />

and complex. At Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />

we are working every day to provide accurate answers<br />

to the questions you pose. We also are working with<br />

various government agencies to clearly understand and<br />

effectively implement the regulations that will result<br />

from the reform legislation passed by Congress.<br />

One of the most frequent questions we answer for<br />

our members relates to cost. Our members are concerned<br />

that, as a result of new regulations, their premium<br />

costs will rise. And that is a valid concern. There are<br />

many provisions in the law that will increase the cost<br />

of health insurance premiums for many people. After<br />

all, health insurance premiums are a reflection of health<br />

care costs. Unfortunately, the new law does little to address<br />

the rising cost of medical services but adds new<br />

rules that will increase administrative requirements and<br />

new fees that will have to be funded.<br />

As we move into the implementation phase of the<br />

new health insurance reform bill, we will be focused on<br />

making coverage affordable for consumers. Arkansas<br />

<strong>Blue</strong> Cross remains committed to working with employers,<br />

providers of care (such as doctors and hospitals)<br />

and state and federal government agencies to reduce<br />

the cost and wasteful use of medical services, which<br />

leads to higher medical premium costs. We will continue<br />

to participate in initiatives that keep people healthy<br />

and help them manage chronic disease. And, we will<br />

work to develop new payment models so that health<br />

care providers are rewarded for providing effective,<br />

high-quality care rather than more care. Also, we will<br />

take a fresh look at how we operate and seek greater<br />

administrative efficiency.<br />

In a period of rapid and radical change in health care,<br />

one thing remains constant. Arkansas <strong>Blue</strong> Cross is<br />

committed to providing our members with peace of<br />

mind, as we have done for more than 60 years. That<br />

commitment is even more important in today’s uncertain<br />

health care environment. So if you have questions<br />

about how health insurance reform will affect your<br />

health care, we hope you will check our Web sites for<br />

our analysis. Or call us. We’re happy to hear from you.<br />

In this rapidly changing health care environment, we<br />

haven’t forgotten who we work for every day. <strong>You</strong>.<br />

3<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


4<br />

T<br />

(PPACA), which was signed into law on March 23,<br />

<strong>2010</strong>, ultimately will touch almost every American. The<br />

provisions of the law will be phased in throughout the<br />

next 10 years, with the most significant changes taking<br />

place in 2014. At this early stage, it is very difficult to<br />

predict what changes are in store for each of us. That is<br />

because there are numerous federal and state entities<br />

that must issue regulations, which will explain to insurance<br />

companies and others involved how the law will<br />

be implemented.<br />

The PPACA will make dramatic changes in the insurance<br />

marketplace. The new law will require all health<br />

insurance policies to contain new benefits. It will require<br />

that health insurers rate health plans in new ways.<br />

Many health industry suppliers will be called upon to<br />

pay new taxes to cover the uninsured, thereby increasing<br />

their costs. The new reform legislation did not<br />

contain substantial provisions to control medical costs,<br />

which are the primary drivers of premium costs. These<br />

facts taken together mean that for most Americans, the<br />

cost of health insurance will rise. By 2014, many Americans<br />

will be eligible for government subsidies, which<br />

will help offset those increases. In the meantime, those<br />

with private insurance should expect there to be some<br />

increase in cost as reform provisions are implemented.<br />

That being said, Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />

and its family of companies are committed<br />

to doing all we can to hold costs down and<br />

help our customers understand how they<br />

will be affected. With the understanding<br />

that the final rules are not in place, described<br />

in this article are the changes we<br />

believe will be required by the new law<br />

during the next 18 months, based on<br />

the kind of policy you have and when<br />

Health Insurance<br />

he Patient Protection and Affordable Care Act you enrolled in it. Until we better understand the requirements,<br />

which will come with the issuance of regulations,<br />

we are not able to accurately price the changes.<br />

If you have health insurance through<br />

your employer and were enrolled before<br />

March 23, <strong>2010</strong> (at least one enrolled person):<br />

Insurance policies that were in place on the day<br />

the law was passed are considered “grandfathered”<br />

plans. The new requirements for these plans are more<br />

limited than for those sold after the law was enacted.<br />

Changes that members enrolled in grandfathered employer<br />

group plans can expect during the next six to 18<br />

months may include:<br />

• New rules around pre-existing<br />

health conditions<br />

for children, which may<br />

mean that children<br />

who are<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Reform & <strong>You</strong><br />

insured under their parent’s health plan do not have<br />

to meet any pre-existing condition waiting periods<br />

even if the parents are required to do so as a result<br />

of some condition of their enrollment (late enrollment,<br />

no prior creditable coverage, etc.).<br />

• Dependents can continue coverage under a parent’s<br />

plan until their 26 th birthday. Dependents are eligible<br />

regardless of student or marital status. Dependents<br />

also are eligible regardless of whether they are<br />

claimed as a dependent on their parent’s tax return.<br />

Policies in place before March 23, <strong>2010</strong>, are allowed<br />

to exclude coverage to dependents if they have access<br />

to their own coverage from<br />

another employer-sponsored<br />

health plan. This exception<br />

expires on Jan. 1, 2014.<br />

(More information on dependent coverage is in the<br />

article on Page 6.)<br />

• Lifetime dollar limits will be removed on “essential<br />

benefits.” The rules and guidelines outlining what<br />

benefits are considered essential have not been<br />

defined by the government as of this printing.<br />

• On most Arkansas <strong>Blue</strong> Cross plans, the lifetime<br />

maximum benefit is currently $5,000,000. This lifetime<br />

benefit would become unlimited.<br />

• The dollar limits for some benefits in place today<br />

may be adjusted by the law. The benefits to which<br />

this regulation applies have not been determined.<br />

If you had an individual or family medical<br />

policy in place March 23, <strong>2010</strong> (in which you<br />

were enrolled):<br />

Insurance policies that were in place on the day the<br />

law was passed are considered “grandfathered” plans.<br />

The new requirements for these plans are more limited<br />

than for those sold after the law was enacted. Changes<br />

that members enrolled in grandfathered plans can expect<br />

during the next six to 18 months<br />

may include:<br />

• Dependents can continue coverage under a parent’s<br />

plan until their 26 th birthday. Dependents are eligible<br />

regardless of student or marital status. Dependents<br />

also are eligible regardless of whether they are<br />

claimed as a dependent on their parent’s tax<br />

return. (More information on dependent coverage<br />

is in the article on Page 6.)<br />

• Lifetime dollar limits will be removed on<br />

“essential benefits.” The rules and guidelines<br />

outlining what benefits are considered<br />

essential have not been defined<br />

by the government as of this printing.<br />

• On most Arkansas <strong>Blue</strong> Cross<br />

Reform, continued on Page 14<br />

5<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Good news for graduates!<br />

Arkansas <strong>Blue</strong> Cross extends health insurance coverage<br />

Health and Human Services to pre-<br />

• Standard pre-existing condition<br />

vent a disruption of services to our<br />

waiting periods will apply.<br />

members.<br />

The following is information on<br />

how this affects you and your adult<br />

child depending on your health<br />

insurance plan:<br />

If you have a fully insured<br />

health care plan through an<br />

employer (small business or<br />

large corporation)<br />

• Dependents who currently are<br />

If you have an individual or<br />

enrolled on their parent’s cover-<br />

family medical insurance<br />

age (regardless of insurance<br />

policy<br />

carrier) as of May <strong>2010</strong>, will be<br />

• Dependents who currently are<br />

allowed to remain on that cover-<br />

enrolled on their parent’s cov-<br />

age as long as they are under<br />

erage as of May <strong>2010</strong>, will be<br />

age 26. These dependents are<br />

6<br />

To help our members who<br />

have dependents who are graduating<br />

from high school or college this<br />

spring or may be “aging off” their<br />

parent’s medical policy, Arkansas<br />

<strong>Blue</strong> Cross and <strong>Blue</strong> Shield has<br />

extended health insurance coverage<br />

for most young adults up to age 26<br />

who currently are covered by their<br />

parent’s individual or fully insured<br />

group plan.<br />

Although this provision of the<br />

health insurance reform law (the<br />

Patient Protection and Affordable<br />

Care Act) becomes effective on the<br />

renewal date of a member’s policy<br />

beginning Sept. 23, <strong>2010</strong>, or after,<br />

Arkansas <strong>Blue</strong> Cross, along with 38<br />

other independent <strong>Blue</strong> Plans, has<br />

extended dependent care coverage<br />

early (it began June 1) at the<br />

request of the U.S. Secretary of<br />

allowed to remain on that coverage<br />

as long as they are under<br />

age 26. Dependents are eligible<br />

regardless of student or marital<br />

status. Dependents also are<br />

eligible regardless of whether or<br />

not they are claimed as a dependent<br />

on their parent’s tax return.<br />

• There will be no rate impact on<br />

this change until renewal on<br />

plans already in place as of<br />

May 15 or before. However, a<br />

premium must be paid to cover<br />

the cost of the dependent.<br />

• Those dependents who are<br />

under age 26, and who lost<br />

eligibility for dependent coverage<br />

earlier, can apply to be added<br />

back to the plan at the effective<br />

date of the regulation, which is<br />

Oct. 1, <strong>2010</strong>.<br />

• These dependents will be subject<br />

to medical underwriting.<br />

eligible regardless of student<br />

or marital status. Dependents<br />

also are eligible regardless of<br />

whether or not they are claimed<br />

as a dependent on their parent’s<br />

tax return.<br />

• Dependents who are under the<br />

age of 26, who were not covered<br />

under their parent’s plan as of<br />

May <strong>2010</strong>, and who lost eligibility<br />

for dependent coverage earlier,<br />

can be added back to the group<br />

plan at the effective date of the<br />

regulation, which is the first<br />

renewal date beginning Oct. 1,<br />

<strong>2010</strong>, or after.<br />

• A special 30-day open enrollment<br />

period for dependents who had<br />

previously aged off their coverage<br />

will be held for each group<br />

health plan beginning on their<br />

renewal date. <strong>You</strong> will receive<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


notification before the open<br />

enrollment period. Dependents<br />

on COBRA due to “aging off”<br />

their parents’ coverage, who are<br />

still younger than 26, also will be<br />

allowed to rejoin the group during<br />

open enrollment. They would<br />

again be eligible for COBRA<br />

when they reach the age of 26.<br />

• Policies in place before March<br />

23, <strong>2010</strong>, are allowed to exclude<br />

coverage to dependents if they<br />

have access to their own coverage<br />

from another employer-sponsored<br />

health plan. This exception<br />

expires on Jan. 1, 2014.<br />

• There is no premium rate impact<br />

until the group’s renewal. However,<br />

a family premium (employee/child)<br />

will continue to be<br />

charged.<br />

• If the current plan covers dependents<br />

to age 27, the change<br />

does not impact their plan (fully<br />

insured large group plans only).<br />

• Although this change will be<br />

made automatically, employer<br />

groups may choose to “opt out.”<br />

If you are an employee of a<br />

self-insured group<br />

• <strong>You</strong>r employer will make the<br />

decision. Employers are being<br />

notified of this industry trend<br />

toward early implementation.<br />

• Without early implementation,<br />

the increase in dependent to<br />

age 26 coverage will take effect<br />

at renewal.<br />

• A special 30-day open enrollment<br />

period for dependents who had<br />

previously aged off their coverage<br />

will be held for each group<br />

health plan beginning on their<br />

renewal date. <strong>You</strong> will receive notification<br />

before the open enrollment<br />

period.<br />

If you have an Arkansas<br />

<strong>Blue</strong> Cross dental plan<br />

through your employer<br />

• Dependent rules are the same<br />

as for the fully insured group<br />

health plans.<br />

• There is no premium rate impact<br />

until the group’s renewal. However,<br />

a family premium (employee/child)<br />

will be charged.<br />

• Although this change will be<br />

made automatically, employer<br />

groups may choose to “opt out.”<br />

Dental plans for<br />

individuals and families<br />

(if you purchased your own<br />

dental plan)<br />

• Dependents who are age 19 and<br />

aging off their parent’s plan can<br />

apply for an individual dental<br />

policy.<br />

If you are a state or public<br />

school employee in Arkansas<br />

• The change to cover dependents<br />

up to age 26 was implemented<br />

on April 1, <strong>2010</strong>, and a 90-day<br />

open enrollment period was given<br />

to employees to add previously<br />

dropped dependents.<br />

• The provisions for adding dependents<br />

prior to plan renewal are<br />

as follows:<br />

° Child must be unmarried.<br />

° Parent’s home is the<br />

primary residence of the<br />

dependent.<br />

° Parent provides bulk of the<br />

financial support.<br />

• After plan renewal, all dependents<br />

up to age 26 can be added<br />

regardless of their residence or<br />

marital status.<br />

If you are a federal<br />

employee (FEP)<br />

• This change does not impact FEP<br />

members until Jan. 1, 2011.<br />

7<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


<strong>You</strong>r health insurance, your health<br />

8<br />

Cal Kellogg, Ph.D., senior vice president and chief strategy<br />

officer for Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />

closely followed health insurance reform as the debate<br />

was waged in Congress and has become an expert on<br />

the resulting Patient Protection and Affordable Care Act<br />

(PPACA). <strong>Blue</strong> & <strong>You</strong> recently sat down with Dr. Kellogg<br />

to discuss the overall effect the new law will have, not<br />

only on the lives of our members, but also on the lives<br />

of all Americans.<br />

What were the goals of health care reform?<br />

Looking back, the initial goal of “health care” reform<br />

legislation was to solve three problems, according<br />

to Dr. Kellogg.<br />

1. Get as many people as possible covered by<br />

health insurance.<br />

2. Address the overall cost of care.<br />

3. Make sure Americans receive high-quality health<br />

care services.<br />

Kellogg said the new law addresses goal No. 1. However,<br />

“that means we have to work on the other two<br />

issues,” he said. “That can be done legislatively, or we<br />

will have to do that as an industry.”<br />

What do our members need to know about<br />

health insurance reform?<br />

According to Kellogg, members need to keep three<br />

important points in mind:<br />

1. Personal Responsibility<br />

As a consumer of health care services, it is important<br />

to take personal responsibility for your own health.<br />

This will benefit you and your family both financially and<br />

personally. “The current reform package doesn’t address<br />

the underlying causes of the increases in medical<br />

costs,” Kellogg said. “People can manage their own<br />

health to prevent illnesses by doing simple things like<br />

eating healthy, exercising and reducing stress — we<br />

just need to be proactive. Rather than saying, ‘let it<br />

happen and then we’ll fix it,’ we should say, ‘let’s do<br />

what we can to prevent illness,’ because the prevented<br />

illness is the one that is the least expensive.”<br />

2. Changes to <strong>You</strong>r Coverage<br />

There will be changes related to your health insurance<br />

coverage because of PPACA. We will keep you<br />

informed through <strong>Blue</strong> & <strong>You</strong> and our Web sites. “While<br />

reform will ensure that more Americans have health<br />

insurance,” Kellogg said, “the coverage will cost more,<br />

simply because of how the changes in the marketplace<br />

are structured by the new law.” He explained that under<br />

reform, individual and family insurance plans will have<br />

rules similar to the current small group insurance plans.<br />

“If you look at the current marketplace, premiums<br />

for small employer groups are about three times higher<br />

Cal Kellogg, Ph.D.<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


care, your future<br />

What you need to know about<br />

health insurance reform<br />

“While reform will<br />

ensure that more<br />

Americans have<br />

health insurance,”<br />

Kellogg said, “the<br />

coverage will cost<br />

more, simply because<br />

of how the changes<br />

in the marketplace<br />

are structured by the<br />

new law.”<br />

than for individual health insurance policies written for<br />

individuals and their families without an employer sponsor,”<br />

Kellogg explained. “This is because small group<br />

health insurance plans are “guaranteed issue,” which<br />

means that employees and their dependents can have<br />

coverage regardless of any health conditions they may<br />

have. In addition, premiums are based in part on the<br />

health conditions of all the employees on the group<br />

plan. So if there are a number of very sick people within<br />

a group, the group premiums will be higher.”<br />

Kellogg said the rates in Arkansas’ current individual<br />

marketplace are some of the lowest in the United<br />

States because of the manner in which the laws in<br />

Arkansas allow health plans to calculate premiums.<br />

Currently, each state has its own set of laws and regulations<br />

that take into<br />

account the unique<br />

circumstances that<br />

may exist in its marketplace.<br />

“If you are<br />

relatively healthy, you<br />

get a much lower<br />

rate,” he said. “If you<br />

are unhealthy, you<br />

may have to pay a<br />

surcharge, or you may<br />

not be offered individual<br />

coverage in the<br />

private marketplace.<br />

<strong>You</strong> would still have access to the high-risk pool, where<br />

the premium rates are closer to the premium rates for<br />

small employer groups.” But beginning in 2014, individual<br />

insurance policies in Arkansas will be required<br />

to be “guaranteed issue” as well. For that reason, the<br />

rates are expected to be closer to what we see in small<br />

employer group health plans today.<br />

In addition, PPACA changes the process and the<br />

factors that insurance companies currently use to set<br />

premium rates. Currently, older individuals generally pay<br />

higher premiums than younger people because they<br />

are likely to need more medical services. But in 2014,<br />

insurance companies will be limited in the difference<br />

in premium charged between an older person and a<br />

younger person. This works out well for you if you are<br />

older and not so well if you are younger.<br />

Also, in 2014, PPACA requires that each state establish<br />

health insurance exchanges or marketplaces where<br />

citizens can go to shop for insurance. At that time, Kellogg<br />

said, a person who buys individual insurance and<br />

whose household income is under 400 percent of the<br />

federal poverty level will receive government subsidies<br />

to help pay for their insurance coverage. Subsidies will<br />

be available to people from 133 percent of the federal<br />

9<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


poverty level up to 400 percent of<br />

to $250, but an older person<br />

the federal poverty level on a sliding<br />

paying $750 might move<br />

scale. People who earn more than<br />

down to $650 a month,” Kel-<br />

400 percent of the poverty level will<br />

logg said. “The impact is go-<br />

not receive a subsidy. “If you are on<br />

ing to vary a lot for people in<br />

the lower end of the scale, you may<br />

the individual policy market.”<br />

not end up paying very much more<br />

Kellogg said the new law<br />

for your policy,” he said, “but if you<br />

doesn’t have as much of<br />

are on the higher end of the scale,<br />

a direct impact on people<br />

you may pay a significant amount.”<br />

ages 65 and older. He noted<br />

10<br />

It is difficult to explain how the<br />

new health insurance reform law<br />

will affect people financially, Kellogg<br />

said, because it depends on their<br />

situation. “Say I’m a 55-year-old<br />

with diabetes. In the current environment,<br />

if I get individual coverage<br />

it may be very expensive because<br />

of my health condition, or I might<br />

not be offered coverage at all in<br />

the private marketplace. But under<br />

the new law, I will be able to get<br />

coverage regardless of my health<br />

condition and it might be a little<br />

less expensive than it would otherwise<br />

have been. This is because<br />

of the new limits in the difference<br />

in premiums that the insurance<br />

company will be able to charge<br />

between an older, unhealthy person<br />

and a younger, healthy individual.<br />

Now, if I’m a single 22-year-old man,<br />

I might see my rates double or triple<br />

because of those same limits, plus<br />

the law’s inclusion of maternity and<br />

other medical services as essential<br />

benefits.<br />

“A young person’s membership<br />

premium might move from $90 up<br />

that they did receive some<br />

immediate relief for prescription<br />

drug coverage and that the<br />

“donut hole” in prescription drug<br />

coverage would close by 2020.<br />

3. The Cost Issue<br />

Health insurance reform does not<br />

fix all the problems in the health<br />

care system. There are still many<br />

important issues to be addressed.<br />

While the new health insurance<br />

reform law deals with access to<br />

insurance, Kellogg said it doesn’t<br />

address the problem of increasing<br />

medical costs. And there is still a<br />

question of whether our medical<br />

system will have the capacity to<br />

serve everyone.<br />

“We are estimating that 500,000<br />

previously uninsured Arkansans will<br />

be able to get coverage,” he said.<br />

“There may be problems with being<br />

able to see doctors as quickly, or<br />

scheduling appointments as easily.<br />

In rural areas, it may be even more<br />

of an issue, because there are fewer<br />

physicians. It also may be a little<br />

bit tighter with the addition of new<br />

Medicaid patients who have not had<br />

insurance and have not been seeing<br />

primary care physicians as frequently<br />

as they should.” There will<br />

be a rise in premiums for young and<br />

healthy people who already have<br />

insurance. Because of this, some<br />

of these individuals may choose not<br />

to pay the higher premiums and go<br />

without coverage.<br />

Some proponents of the new law<br />

have said there will be a windfall<br />

for the insurance companies with<br />

all the new people in the system,<br />

but Kellogg said it doesn’t necessarily<br />

work out that way. “Yes, there<br />

will be new people in the system,<br />

but they may not be as healthy,<br />

and that is going to drive costs,” he<br />

explained. “Our experience is that<br />

folks who have not had insurance,<br />

and then get coverage, tend to use<br />

their coverage quite a bit, which<br />

creates higher volume. <strong>You</strong> take all<br />

those things together and we could<br />

run into some supply problems.”<br />

Advice to Members<br />

Kellogg suggested members not<br />

make any significant changes in their<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Making the Most of It<br />

will take to comply, including the im-<br />

Going forward, Kellogg<br />

plications for them and positives and<br />

said, Arkansas <strong>Blue</strong> Cross<br />

negatives for some of the choices<br />

will focus on ways to effec-<br />

they may make,” he said. “So, hope-<br />

tively pay for benefits and to<br />

fully, that will help our members<br />

provide information to help<br />

if they have employer coverage.<br />

customers find the most<br />

Employers are going to be struggling<br />

effective treatments and the<br />

to understand this; this isn’t their<br />

places with the best out-<br />

business, this is our business, so<br />

comes. “And we want to pay<br />

we’d better be the experts on it and<br />

coverage until there is more information<br />

about the regulations. “The law<br />

has been passed, but the regulations<br />

that define the law really don’t<br />

exist yet. And, until they exist, we<br />

don’t really know exactly how things<br />

will work.”<br />

For example, Kellogg said, the law<br />

discusses “essential benefits,” which<br />

are medical services that every<br />

health insurance plan in the country<br />

will be required to cover, but the regulations<br />

don’t exist to explain which<br />

benefits are considered “essential.”<br />

We have to understand the details<br />

in the regulations before you start<br />

making changes.<br />

Kellogg said that for the<br />

next six to 18 months the law is in<br />

the implementation stage, which<br />

will include some minor changes<br />

and explanation of the law through<br />

regulations. “<strong>You</strong> are not going to<br />

see major changes until 2014,<br />

when these significant structural<br />

changes will happen to the<br />

insurance market.”<br />

providers — not for the number<br />

of services they provide<br />

— but for the outcomes that they<br />

generate for their patients,” he said.<br />

“We can help people identify where<br />

there is waste in the system and<br />

get rid of it. And, if we do all these<br />

things in a relatively short time, then<br />

we can lessen the cost impact that<br />

reform will otherwise have on our<br />

members.”<br />

Implementation<br />

Kellogg said that Arkansas <strong>Blue</strong><br />

Cross is working to understand the<br />

regulations as quickly as they are<br />

announced and will implement them<br />

in a timely, organized fashion with<br />

minimal disruption. “Hopefully, for<br />

our members, transitions will be as<br />

painless as possible and they hardly<br />

will notice that they’ve happened,”<br />

he said, “unless it’s a situation<br />

where they have the opportunity<br />

to extend coverage for their child<br />

or whatever the situation might be<br />

and then we will have a process for<br />

doing that.”<br />

“We also are going to try to keep<br />

help them.”<br />

What is the Silver Lining?<br />

Kellogg said that under reform<br />

many previously uninsured people<br />

will now have access to coverage.<br />

“And, beginning in 2014, if you have<br />

a lower income, there will be significant<br />

government subsidies and<br />

it won’t cost you as much for insurance.<br />

For those groups it is positive.”<br />

But that silver lining isn’t for<br />

everyone. “For the rest of the folks,<br />

the subsidies have to come from<br />

taxes, so the increased tax burden<br />

will be out there,” Kellogg said. “And<br />

for people who are at or above 400<br />

percent of the federal poverty level,<br />

they won’t get any subsidy and<br />

there will be added costs.”<br />

But Kellogg said the efforts to<br />

change health care have only just<br />

begun. “The other positive is now<br />

that the issue of access has been<br />

addressed, we can focus on other<br />

major issues, like cost and quality,”<br />

he said. “I guess that is the biggest<br />

positive.”<br />

11<br />

employer groups informed of what it<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


12<br />

Need more information<br />

before visiting a specialist?<br />

We can help!<br />

If you are planning a visit to the doctor and need a little more information<br />

on what medical care may be appropriate for you, Physician<br />

Connection can help. Physician Connection allows you (as a member)<br />

to find quality information for a specific health condition or physician<br />

specialty.<br />

Quality information is available Physician Connection is available<br />

exclusively for members to<br />

for health conditions such as pregnancy,<br />

diabetes, heart, eye and help you make informed health<br />

respiratory conditions. The quality decisions. It’s available in the<br />

information also is available for secure My <strong>Blue</strong>print sections of<br />

the following specialties: allergy/ our Web sites — arkansasbluecross.com,<br />

healthadvantage-<br />

immunology, cardiology, endocrinology,<br />

family practice, internal hmo.com and blueadvantagearkansas.com.<br />

Visit the home<br />

medicine, neurology, obstetrics/<br />

gynecology, ophthalmology, otolaryngology,<br />

pediatric medicine,<br />

page to register or log in.<br />

pulmonary diseases and urology.<br />

What is quality information?<br />

Medical experts have established guidelines that most informed<br />

practitioners believe physicians should follow in many — but not all —<br />

situations. Quality measures show how often physicians in our network<br />

(as a group) provide frequently recommended treatments to their<br />

patients.<br />

Within Physician Connection on our Web sites, under the section<br />

called “Quality measures for my physician’s specialty,” you can select a<br />

physician specialty, read the recommended treatment options (quality<br />

measure) for specific conditions, and review a graph that shows how<br />

often physicians in that specialty followed the recommended treatment<br />

(quality measure) for their patients.<br />

In a similar section on our Web sites called “Quality measures for my<br />

health condition,” you can select a health condition (such as diabetes)<br />

and review the graph that shows (by specialty) how often physicians<br />

who treat diabetes followed the recommended treatment (quality measure)<br />

for their patients.<br />

Lose<br />

weight<br />

The Healthy<br />

Weigh!<br />

The Healthy Weigh! Education<br />

Program is free for members of<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />

Health Advantage (except state and<br />

public school employees*), <strong>Blue</strong> Cross<br />

and <strong>Blue</strong> Shield Service Benefit Plan<br />

(Federal Employee Program), Medi-Pak<br />

Advantage (PFFS) and eligible members<br />

of <strong>Blue</strong>Advantage Administrators<br />

of Arkansas.<br />

To enroll, complete the attached<br />

enrollment form and return it in the<br />

self-addressed, postage-paid envelope<br />

included in this magazine. The program<br />

starts when you enroll.<br />

After enrollment, you will begin to<br />

receive information through the mail,<br />

which you can read in the privacy of<br />

your own home and at your own pace.<br />

The program is completely voluntary,<br />

and you may leave the program at any<br />

time. If you have further questions<br />

about the program, call the Health<br />

Education Program’s toll-free number<br />

at 1-800-686-2609.<br />

* Our state and public school members can<br />

access the “Nourish” program through<br />

Life Synch.<br />

Simply complete, sign and return the<br />

attached enrollment form in the selfaddressed,<br />

postage-paid envelope.<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Chronic job stress and your waistline<br />

Are you stressed out at work? Worried about job<br />

security? Feeling like you have little control? Chronic<br />

stress may be adding to employees’ waistlines, according<br />

to a recent study conducted by the University of<br />

Rochester Medical Center.<br />

Researchers found that workers who suffered from<br />

chronic job stress had a higher Body Mass Index (BMI)<br />

than less stressed workers. According to the study,<br />

workers dealing with chronic stress tended to look “forward<br />

to going home and ‘vegging out’ in front of the<br />

TV.” And, when layoffs were occurring, the unhealthiest<br />

snacks were the first to go from vending machines. Employees<br />

noted that they did not take time to exercise or<br />

eat better in order to remain at their desks.<br />

One conclusion that the study made is that employers<br />

should “focus on strengthening wellness programs<br />

to provide good nutrition, ways to deal with job demands<br />

and more opportunities for physical activities<br />

that are built into the regular workday without penalty.”<br />

Sources: University of Rochester Medical Center,<br />

msnbc.com<br />

13<br />

How much exercise do<br />

women really need?<br />

We’ve all heard the standard 30 minutes a day, most<br />

days of the week recommendation. But recent research<br />

shows that may not be enough for women as they age.<br />

According to a study in the Journal of the American<br />

Medical Association, middle-aged women may actually<br />

need closer to 60 minutes a day of moderate-intensity<br />

exercise. Don’t be discouraged so quickly. The study<br />

uses Metabolic Equivalent (MET) hours. To put it into<br />

perspective, 1 MET would be equivalent to lying in bed<br />

for an hour while running at 6 mph would equal approximately<br />

10 METs.<br />

So, in order to meet the 60-minute recommendation<br />

to prevent weight gain,<br />

middle-aged women would<br />

need to aim for a minimum of<br />

21 METs per week. To hit those<br />

MET requirements in less time,<br />

up the intensity of your workouts,<br />

which will allow you to<br />

meet the MET requirements<br />

in less than an hour a day.<br />

Source: Health.com<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Reform, continued from Page 5<br />

14<br />

plans, the lifetime maximum benefit is currently<br />

$5,000,000. This lifetime benefit would become<br />

unlimited.<br />

If you were enrolled in a health plan<br />

through your employer effective April 1,<br />

<strong>2010</strong>, or after:<br />

For more recently effective health plans, a number of<br />

changes apply during the next six to 18 months. These<br />

changes may include:<br />

• New rules around pre-existing health conditions for<br />

children, which may mean that children who are insured<br />

under their parent’s health plan do not have to<br />

meet any pre-existing condition waiting periods even<br />

if the parents are required to do so as a result of<br />

some condition of their enrollment (late enrollment,<br />

no prior creditable coverage, etc.).<br />

• Dependents can continue coverage under a parent’s<br />

plan until their 26 th birthday. Dependents are eligible<br />

regardless of student or marital status. Dependents<br />

also are eligible regardless of whether they are<br />

claimed as a dependent on their parent’s tax return.<br />

(More information on dependent coverage is in the<br />

article on Page 6.)<br />

• Lifetime dollar limits will be removed on “essential<br />

benefits.” The rules and guidelines outlining what<br />

benefits are considered essential have not been<br />

defined by the government as of this printing.<br />

• On most Arkansas <strong>Blue</strong> Cross plans, the lifetime<br />

maximum benefit is currently $5,000,000. This lifetime<br />

benefit would become unlimited.<br />

• The dollar limits for some benefits in place today<br />

may be adjusted by law. The benefits to which this<br />

regulation applies have not been determined.<br />

• Emergency services must be covered at the innetwork<br />

coinsurance or copayment level even if you<br />

receive the services at an out-of-network facility.<br />

(This benefit is already offered by Arkansas <strong>Blue</strong><br />

Cross and Health Advantage.)<br />

• Access to any in-network primary care physician or<br />

pediatrician who is accepting new patients. (Already<br />

available.)<br />

• Direct access for women to obstetricians/gynecologists<br />

without a referral.<br />

• Preventive services identified by the U.S. Preventive<br />

Services Task Force will be covered with no member<br />

cost-sharing (copayments, deductibles or coinsurance.)<br />

The specific services that will be covered have<br />

not yet been identified.<br />

If you were enrolled in a family or<br />

individual medical policy on April 1, <strong>2010</strong>,<br />

or after:<br />

For more recently effective health plans, a number<br />

of changes apply over the next six to 18 months. These<br />

changes may include:<br />

• New rules around pre-existing health conditions for<br />

children which may mean that children who are in-<br />

For more information on health insurance reform,<br />

go to our Web sites or call Customer Service<br />

(telephone numbers found on Page 23).<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


sured under their parent’s health plan do not have to<br />

meet any pre-existing condition waiting periods even<br />

if the parents are required to do so.<br />

• Dependents can continue coverage under a parent’s<br />

plan until their 26 th birthday. Dependents are eligible<br />

regardless of student or marital status. Dependents<br />

also are eligible regardless of whether they are<br />

claimed as a dependent on their parent’s tax return.<br />

(More information on dependent coverage is in the<br />

article on Page 6.)<br />

• Lifetime dollar limits will be removed on “essential<br />

benefits.” The rules and guidelines outlining what<br />

benefits are considered essential have not been<br />

defined by the government as of this printing.<br />

• On most Arkansas <strong>Blue</strong> Cross plans, the lifetime<br />

maximum benefit is currently $5,000,000. This lifetime<br />

benefit would become unlimited.<br />

• The dollar limits for some benefits in place today<br />

may be adjusted by law. The benefits to which this<br />

regulation applies have not been determined.<br />

• Emergency services must be covered at the innetwork<br />

coinsurance or copayment level even if you<br />

receive the<br />

services at<br />

an out-ofnetwork<br />

facility. (Arkansas <strong>Blue</strong> Cross already offers<br />

this benefit.)<br />

• Access to any in-network primary care physician or<br />

pediatrician who is accepting new patients. (Already<br />

available.)<br />

• Preventive services identified by the U.S. Preventive<br />

Services Task Force will be covered with no member<br />

cost-sharing (copayments, deductibles or coinsurance).<br />

The specific services that will be covered have<br />

not yet been identified.<br />

• Direct access for women to obstetricians/gynecologists<br />

without a referral will be included in all policies.<br />

In addition to the new requirements described above,<br />

PPACA includes additional regulations that may impact<br />

members. These provisions include:<br />

• New appeals processes will be established.<br />

• The federal Department of Health and Human Services<br />

will create a Web site to facilitate consumer<br />

and small group health plan shopping.<br />

• State ombudsman programs will be established.<br />

• Over-the-counter drugs not prescribed by a physician<br />

can no longer be reimbursed from a flexible spending<br />

account or HRA.<br />

These are the changes you can expect in the next<br />

six to 18 months. As regulations are clarified, Arkansas<br />

<strong>Blue</strong> Cross will notify you of those provisions that<br />

impact your policy. Most importantly, we will keep you<br />

informed of the impact these changes may have on<br />

your rates.<br />

The most substantial changes will be implemented<br />

in 2014. Those provisions will change where and how<br />

you buy insurance, how it is priced and how you pay for<br />

it. As regulations are issued, Arkansas <strong>Blue</strong> Cross will<br />

provide you with as much information as possible to<br />

help explain health insurance reform and its impact on<br />

the health care industry. Please visit our Web sites or<br />

contact us with any questions you may have.<br />

15<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Lifelong Health<br />

with Dr. David<br />

16<br />

David A. Lipschitz, M.D., Ph.D.<br />

For women, heart attack<br />

prevention and education<br />

are key<br />

In recent years, American women have become increasingly<br />

aware that heart disease is not just a “man’s<br />

issue.” Before menopause, a woman’s risk of heart<br />

attacks is lower than a man’s. But post-menopause, the<br />

risk slowly increases, and within a decade both sexes<br />

have similar statistics. We now know that in the last<br />

two decades of life, a woman’s risk of heart attack and<br />

death from heart disease is significantly greater than<br />

a man’s.<br />

In many women, coronary artery disease is different<br />

from that found in men. Women tend to deposit<br />

cholesterol and fats uniformly throughout their arteries,<br />

whereas men tend to have more localized disease. This<br />

may make women less prone to a massive heart attack,<br />

but more likely to have different symptoms, including<br />

potentially fatal abnormal heart rhythms. Prior to menopause,<br />

estrogens protect the heart from the ravages<br />

of a sedentary and stressful lifestyle, unhealthy diets,<br />

elevated cholesterol levels and smoking. However, after<br />

menopause, the protection disappears and hormone replacement<br />

therapy seems to make the problem worse<br />

rather than better.<br />

As women grow older, heart attacks become more<br />

common, but the symptoms are quite different from<br />

our stereotypic expectations. Most Americans imagine<br />

a heart attack to be preceded by a sudden crushing,<br />

centralized chest pain that feels as if the chest is in a<br />

vice. This is rarely the case. For many women, chest<br />

pain is not the initial symptom. Instead, symptoms<br />

can be extremely varied, including a sudden shortness<br />

of breath, palpitations,<br />

nausea and vomiting,<br />

or feeling<br />

clammy and<br />

ill. If chest<br />

pain does<br />

occur, it<br />

frequently<br />

is atypical,<br />

meaning it<br />

For many women,<br />

chest pain is not the initial<br />

symptom. Instead, symptoms<br />

can be extremely varied,<br />

including a sudden shortness<br />

of breath, palpitations, nausea<br />

and vomiting, or feeling<br />

clammy and ill.<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Editor’s Note: David A. Lipschitz, M.D., Ph.D., is nationally<br />

recognized as a leader in the field of geriatrics.<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield is honored to have<br />

him as a contributor to <strong>Blue</strong> & <strong>You</strong> magazine.<br />

doesn’t fit the classic description of pain associated<br />

with a heart attack. It may be in the back or abdomen<br />

and is often attributed to a muscle strain or indigestion.<br />

Frequently there is no pain at all or merely a feeling of<br />

pressure or tightness across the chest or throat.<br />

Heart attacks with atypical symptoms or no chest<br />

pain are frequently misdiagnosed, or diagnosed after it<br />

is too late. A recent report published in a major medical<br />

journal showed that pain-free heart attacks, particularly<br />

common in older women, are three times more likely to<br />

be fatal than those with typical symptoms.<br />

There are some very important lessons to be learned<br />

from this information. Women must remember that<br />

they are not immune to heart disease. From a young<br />

age, all women must pay attention to a heart-healthy<br />

lifestyle of diet, exercise and stress management. If<br />

medical concerns are present, such as high blood pressure<br />

and elevated cholesterol, they should be treated<br />

and managed.<br />

In addition to prevention, women need to be more<br />

informed and aware of the initial symptoms of heart<br />

attacks. Do not ignore a sudden shortness of breath,<br />

sweating, nausea, vomiting or unexplained palpitations.<br />

Never ignore an unusual pain such as a heaviness or<br />

tightness in the chest, pain in the back, arm or abdomen,<br />

particularly if you have never had anything like this<br />

before. The sudden onset of any of these symptoms<br />

is best handled by taking an aspirin and calling 911; it<br />

could save your life. When it comes to issues of the<br />

heart, it is far better to be safe than sorry!<br />

17<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Warning issued for “baby slings”<br />

18<br />

The U.S. Consumer Product Safety<br />

Commission (CPSC) has issued a<br />

warning concerning the use of infant<br />

carriers known as “baby slings.”<br />

A baby sling is a soft fabric carrier<br />

with a padded shoulder strap connecting<br />

to a hammock-style cradle<br />

that is worn by an adult. The warning<br />

was issued after three infants suffocated<br />

in baby slings in 2009.<br />

Babies younger than four months<br />

old have very weak neck muscles<br />

and can’t control their heads. An<br />

infant can suffocate in as little as two<br />

minutes if the strap from a baby sling<br />

covers his/her nose and mouth.<br />

Also, baby slings can force an<br />

infant’s chin downward to his or her<br />

chest, making breathing difficult and<br />

possibly causing a slower suffocation.<br />

Children with breathing problems<br />

and a low birth weight are at a<br />

higher risk.<br />

The CPSC has not issued a recall<br />

on baby slings, but advises parents<br />

to take special care when using the<br />

device. Specifically, parents should:<br />

• Place the child’s chin up<br />

with his/her face clearly<br />

visible.<br />

• Check on the child<br />

often.<br />

• Do not allow the sling to cover<br />

the child’s face.<br />

• Do not carry the child too low in<br />

the sling.<br />

• Do not carry the child hunched,<br />

with his/her chin touching<br />

the chest.<br />

• Do not carry the child with his/her<br />

face pressed tightly against the<br />

wearer of the sling.<br />

Can<br />

breastfeeding<br />

save lives?<br />

Nearly 900 babies could be saved<br />

each year, along with billions of dollars,<br />

if 90 percent of U.S. women<br />

fed their babies only breast milk<br />

for the first six months of life, according<br />

to a cost analysis published<br />

in the April issue of the journal<br />

Pediatrics.<br />

The analysis studied the prevalence<br />

of 10 common childhood<br />

illnesses, costs of treatment, including<br />

hospitalization, and the level of<br />

disease protection other studies<br />

have linked with breastfeeding.<br />

Breastfeeding is thought to protect<br />

against stomach viruses, ear infections,<br />

asthma, juvenile diabetes,<br />

sudden infant death syndrome and<br />

even childhood leukemia.<br />

The $13 billion in estimated<br />

losses includes an economist’s calculation<br />

partly based on lost potential<br />

lifetime wages — $10.56 million<br />

per death.<br />

The methods were similar to<br />

a widely cited 2001 government<br />

report that said $3.6 billion could<br />

be saved each year if 50 percent of<br />

mothers breastfed their babies for<br />

six months. Medical costs have<br />

climbed since then, and breastfeeding<br />

rates have increased only<br />

slightly.<br />

About 43 percent of U.S. mothers<br />

do at least some breastfeeding for<br />

six months, but only 12 percent follow<br />

government guidelines recommending<br />

that babies receive only<br />

breast milk for six months.<br />

Source: Pediatrics, Associated Press<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Redesigned PHS wins top scores<br />

in national review<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield’s new Personal Health Statement<br />

— a redesign of the traditional<br />

Explanation of Benefits (EOBs) —<br />

earned a first-place finish, as well as<br />

a designation of “Excellent,” during a<br />

recent national review of insurance<br />

companies’ EOBs.<br />

The EOB, which is generated each<br />

time a member’s doctor or hospital<br />

files a claim, is the primary way<br />

Arkansas <strong>Blue</strong> Cross communicates<br />

with its members. The goal was to<br />

simplify and personalize the benefit<br />

statement so members will understand<br />

exactly what is happening with<br />

their claims and their benefits.<br />

The new Personal Health Statement<br />

is designed to help members<br />

understand a complex industry in<br />

everyday language.<br />

It helps members:<br />

• Understand claims and how they<br />

were handled.<br />

• Monitor out-of-pocket costs<br />

(deductibles, copayments,<br />

coinsurance)<br />

• See benefits and how they work.<br />

• Have a better understanding of<br />

discounts on services.<br />

• Know how to contact their health<br />

insurance plan.<br />

• Have a quick understanding of<br />

how much they owe and<br />

to whom.<br />

DALBAR, a leading third-party<br />

evaluator in the financial services<br />

industry, conducted this first-ever<br />

national evaluation of the EOB. The<br />

evaluation gave 68 percent of EOBs<br />

failing grades. Arkansas <strong>Blue</strong> Cross,<br />

however, was deemed innovative<br />

for recognizing the importance<br />

of this member communication<br />

and transforming its EOBs into<br />

Personal Health Statements that<br />

are understandable and useful<br />

consumer tools.<br />

The DALBAR report evaluates<br />

EOBs according to clarity, content<br />

and design. Three DALBAR designations<br />

are used: Excellent: 80-100<br />

points, Very Good: 70-79 points and<br />

Good: 60-69 points.<br />

19<br />

Food for thought:<br />

Certain foods may keep aging brains healthy<br />

Eating a Mediterranean diet may<br />

help keep your brain healthy as<br />

you age, findings from an ongoing<br />

study show.<br />

A “Mediterranean diet” encourages<br />

the following:<br />

• Vegetables<br />

• Fruits<br />

• More fish, less meat<br />

• Olive oil<br />

• Moderate wine<br />

• Whole grains<br />

• Nuts and seeds<br />

The study included 4,000 adults<br />

aged 65 and older who were given<br />

series of tests to examine their<br />

mental abilities every three years<br />

during a 15-year period. Those who<br />

scored highest in following a Mediterranean<br />

diet were least likely to<br />

suffer cognitive decline, the study<br />

authors found.<br />

Source: National Institutes of Health<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


What’s in a drug name<br />

and why did mine change?<br />

20<br />

Every drug usually has three stems include suffixes like -mab for<br />

names: the chemical name, the monoclonal antibodies, such as infliximab.<br />

Names that include stems,<br />

generic name and the brand name.<br />

Each name is subject to different chemistry roots or other coded<br />

rules and regulations.<br />

information are easier to remember<br />

The chemical name specifies the and give clues to the drug’s use.<br />

chemical structure of the drug. It These names, however, may sound<br />

does not have to be preapproved by or look alike and can contribute to<br />

any organization. Chemical names medication errors.<br />

are primarily used by researchers The brand name is created as<br />

but not in medical practice.<br />

soon as a generic name has been<br />

The generic name usually is created<br />

when a new drug is ready for between drug names that look or<br />

established. To minimize confusion<br />

marketing. It is selected by the U.S. sound alike, the FDA rejects about<br />

Adopted Names (USAN) Council, one-third of an average of 400 possible<br />

brand names submitted based on<br />

whose expertise is recognized by<br />

the U.S. Food and Drug Administration<br />

(FDA), according to principles Still, confusion from similar-<br />

similarities with other drug names.<br />

developed to ensure safety, consistency<br />

and logic. These names To monitor the situation, the FDA<br />

sounding drug names does occur.<br />

typically are used by health care has a medication errors committee<br />

professionals.<br />

that occasionally recommends a<br />

Generic names are made using name change.<br />

an established stem, or group of The most recent name change<br />

letters, that represents a specific happened this year. Kapidex ®<br />

drug class. For example, the USAN (dexlansoprazole), a proton pump<br />

From the<br />

inhibitor that hit the market in February<br />

2009, became confused with<br />

the similar-sounding drug name<br />

Casodex ® . The FDA committee<br />

recommended a name change for<br />

Kapidex ® and effective April <strong>2010</strong>, it<br />

became Dexilant ® .<br />

The last time the FDA changed<br />

a drug name after it was approved<br />

was in 2005, when the Alzheimer’s<br />

medication Reminyl ® was confused<br />

with the diabetes drug Amaryl ® and<br />

one person died. The Alzheimer’s<br />

medicine now is called Razadyne.<br />

The need to change a drug’s<br />

name does not happen often and<br />

usually occurs within the first year<br />

a drug is marketed. The complex<br />

procedure of giving each drug a<br />

chemical, generic and brand name<br />

does not always eliminate confusion.<br />

However, the pharmaceutical<br />

companies, the USAN Council and<br />

the FDA all share one basic goal —<br />

to create a name for each drug that<br />

easily distinguishes it from other<br />

drug names, ensuring patient safety.<br />

Pharmacist<br />

Source: fda.gov<br />

by Trey Gardner, Pharm D.,<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


The<br />

Doctor’s<br />

Corner<br />

No smoking!<br />

Two new studies have determined<br />

that smoking bans in public<br />

by Ray Bredfeldt, M.D.,<br />

Regional Medical Director<br />

Northwest Region, Fayetteville<br />

Drugs used to treat high<br />

blood pressure also may<br />

keep dementia away<br />

ACE-inhibitors are commonly<br />

used to treat high blood pressure,<br />

but evidence now indicates that<br />

these same medications also may<br />

prevent the worsening of dementia.<br />

Researchers recently discovered<br />

that people who take “centrally active”<br />

ACE-inhibitors (examples are<br />

captopril and lisinopril) had memory<br />

function that declined 65 percent<br />

less when compared to those not<br />

taking these same medications. Of<br />

course, more research needs to be<br />

completed, but for someone with<br />

dementia who already is taking high<br />

blood pressure medications, switching<br />

to one of these medications<br />

might be something to consider.<br />

places significantly reduces the rate<br />

of heart attacks. The studies found<br />

that the overall rate of heart attacks<br />

in cities that have banned smoking<br />

in public places has decreased by as<br />

much as 36 percent during a threeyear<br />

study. Exposure to smoke (or<br />

smoking) can cause blood vessels<br />

of the heart to constrict, which can<br />

cause a heart attack. One of the<br />

studies, published recently in the<br />

Journal of the American College of<br />

Cardiology, estimated that a nationwide<br />

smoking ban in public places<br />

could prevent more than 150,000<br />

heart attacks each year.<br />

No link between cell phones<br />

and brain cancer<br />

Someone may have sent you an<br />

e-mail or some sort of “document”<br />

that suggests that radio waves from<br />

cell phones cause an increase in<br />

brain cancer. Scientists have found<br />

no evidence that radio waves can<br />

damage a cell’s DNA, which would<br />

be necessary for cancer to occur<br />

from cell phones. Now, a new<br />

study gives further assurances of<br />

the apparent safety of cell phones<br />

related to radio waves and brain<br />

cancer. Researchers have found no<br />

increase in the rate of brain cancer<br />

in four different countries during the<br />

10 years after a significant increase<br />

in cell phone use occurred in those<br />

countries.<br />

Take folic acid prior to<br />

pregnancy<br />

For many years, doctors have recommended<br />

that women take folic<br />

acid (vitamin B9) during pregnancy<br />

to help prevent birth defects. Now,<br />

evidence suggests that taking folic<br />

acid prior to getting pregnant has<br />

definite advantages. Women thinking<br />

about getting pregnant should<br />

probably start taking folic acid up to<br />

one year prior to becoming pregnant.<br />

A recent study discovered that<br />

women who take folic acid before<br />

getting pregnant reduce their risk of<br />

having a premature baby by 50 to<br />

70 percent. The recommended preconception<br />

dose of folic acid is 400<br />

micrograms per day.<br />

21<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />

Financial Information Privacy Notice<br />

At Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield and its affiliates (including<br />

HMO Partners, Inc. d/b/a Health<br />

Advantage), we understand how<br />

important it is to keep your private<br />

purchase and use of our<br />

products.<br />

• Information related to the fact<br />

that you have been or currently<br />

are a member.<br />

information. Improper access and<br />

use of confidential information by an<br />

employee can result in disciplinary<br />

action up to and including termination<br />

of employment.<br />

22<br />

information just that — private.<br />

Because of the nature of our<br />

business, we must collect some<br />

personal information from our<br />

members, but we also are committed<br />

to maintaining, securing and<br />

protecting that information.<br />

Customer Information<br />

Arkansas <strong>Blue</strong> Cross and its<br />

Sharing of Information<br />

Arkansas <strong>Blue</strong> Cross and its<br />

affiliates do not disclose, and do not<br />

wish to reserve the right to disclose,<br />

non-public personal information about<br />

you to one another or to other parties<br />

except as permitted or required by<br />

law. Examples of instances in which<br />

Arkansas <strong>Blue</strong> Cross and its affiliates<br />

Disclosure of Privacy Notice<br />

Arkansas <strong>Blue</strong> Cross and its<br />

affiliates recognize and respect the<br />

privacy concerns of potential, current<br />

and former customers. Arkansas <strong>Blue</strong><br />

Cross and its affiliates are committed<br />

to safeguarding this information. As<br />

required by state regulation, we must<br />

notify our members about how we<br />

affiliates only compile information<br />

will provide information to one<br />

handle non-public financial information<br />

necessary for us to provide the<br />

another or other third parties are:<br />

of our members. If you would like<br />

services that you, our member,<br />

request from us and to administer<br />

your business. We collect non-public<br />

personal financial information (defined<br />

as any information that can be tied<br />

back to a specific person and is<br />

gathered by any source that is<br />

not publicly available) about our<br />

members from:<br />

• Applications for insurance coverage.<br />

The application includes<br />

information such as name, address,<br />

personal identifiers such<br />

as Social Security number, and<br />

medical information that you<br />

authorize us to collect.<br />

• Payment history and related<br />

financial transactions from the<br />

• To service or process products<br />

that you have requested.<br />

• To provide information as permitted<br />

and required by law to<br />

accrediting agencies.<br />

• To provide information to comply<br />

with federal, state or local<br />

laws in an administrative or<br />

judicial process.<br />

How We Protect <strong>You</strong>r<br />

Information<br />

Arkansas <strong>Blue</strong> Cross and its<br />

affiliates use various security<br />

mechanisms to protect your personal<br />

data including electronic and physical<br />

measures as well as company<br />

policies that limit employee access<br />

to non-public personal financial<br />

to review the Financial Information<br />

Privacy Notices for all Arkansas <strong>Blue</strong><br />

Cross members, you can visit our Web<br />

site at arkansasbluecross.com or call<br />

the appropriate Arkansas <strong>Blue</strong> Cross<br />

affiliate company to receive the Privacy<br />

Notice. Our customer service areas<br />

are open from 8 a.m. to 4:30 p.m.,<br />

Central time, Monday through Friday.<br />

To receive a copy of the Privacy<br />

Notice, members should call:<br />

Arkansas <strong>Blue</strong> Cross —<br />

1-800-238-8379.<br />

Health Advantage — 1-800-843-1329.<br />

Self-funded group members should<br />

call Customer Service using the tollfree<br />

telephone number on their<br />

ID card.<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


Heart-healthy walking<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield employees<br />

raised more than $8,000 for the American Heart Association<br />

<strong>2010</strong> Central Arkansas Heart Walk, which was held<br />

April 17 at the North Shore River Walk in downtown<br />

North Little Rock. Mike Brown, executive vice president<br />

and chief operating officer, served as the overall Central<br />

Arkansas Heart Walk chairman and launched thousands<br />

of participants for the 5K, including more than 300<br />

Arkansas <strong>Blue</strong> Cross employees.<br />

<strong>Blue</strong>Ann leads Anti-Drug<br />

Walk in Arkadelphia<br />

For the 12th year, <strong>Blue</strong>Ann Ewe helped lead the annual<br />

“Just Say No” drug prevention walk hosted by Perritt<br />

Primary School in Arkadelphia. On April 9, <strong>Blue</strong>Ann<br />

helped lead the fight against drugs with hundreds of<br />

elementary students, high school and college mentors,<br />

parents, teachers and administration staff, and community<br />

supporters during the 23rd year of the event. Community<br />

and state leaders greeted the walkers, pledging<br />

their support in the fight against drugs. Clark County<br />

Sheriff’s Office<br />

staff, Arkadelphia<br />

Police<br />

Department<br />

officers and<br />

members<br />

of the Arkadelphia<br />

Fire<br />

Department<br />

Rescue Unit<br />

participated<br />

as well.<br />

We love to hear from you!<br />

May we help? For customer service, please call:<br />

Little Rock<br />

Number (501)<br />

Toll-free<br />

Number<br />

Medi-Pak members 378-3062 1-800-338-2312<br />

Medi-Pak Advantage members 1-877-233-7022<br />

Medi-Pak Rx members 1-866-390-3369<br />

Arkansas <strong>Blue</strong> Cross members 378-<strong>2010</strong> 1-800-238-8379<br />

Pharmacy questions 1-800-863-5561<br />

Specialty Rx Pharmacy questions 1-866-295-2779<br />

Health Advantage members 378-2363 1-800-843-1329<br />

Pharmacy questions 1-800-863-5567<br />

<strong>Blue</strong>Advantage members 378-3600 1-888-872-2531<br />

Pharmacy questions 1-888-293-3748<br />

State and Public School members 378-2364 1-800-482-8416<br />

Federal Employee members 378-2531 1-800-482-6655<br />

Looking for health or dental insurance? We can help!<br />

For individuals, families<br />

and those age 65 or older 378-2937 1-800-392-2583<br />

For employer groups 378-3070 1-800-421-1112<br />

(Arkansas <strong>Blue</strong> Cross Group Services, which includes<br />

Health Advantage and <strong>Blue</strong>Advantage Administrators<br />

of Arkansas)<br />

Prefer to speak with someone close to home? Call or visit one<br />

of our regional offices:<br />

Pine Bluff/Southeast Region 1-800-236-0369<br />

1800 West 73rd St.<br />

Jonesboro/Northeast Region 1-800-299-4124<br />

707 East Matthews Ave.<br />

Hot Springs/South Central Region 1-800-588-5733<br />

100 Greenwood Ave., Suite C<br />

Texarkana/Southwest Region 1-800-470-9621<br />

1710 Arkansas Boulevard<br />

Fayetteville/Northwest Region 1-800-817-7726<br />

516 East Milsap Rd., Suite 103<br />

Fort Smith/West Central Region 1-866-254-9117<br />

3501 Old Greenwood Rd., Suite 5<br />

Little Rock/Central Region 1-800-421-1112<br />

320 West Capitol Ave., Suite 900<br />

<strong>You</strong> can contact customer service through our Web sites:<br />

arkansasbluecross.com<br />

healthadvantage-hmo.com<br />

blueadvantagearkansas.com<br />

Related Web sites:<br />

blueandyoufoundationarkansas.org<br />

blueannewe-ark.com<br />

23<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>


24<br />

At Arkansas <strong>Blue</strong> Cross<br />

and <strong>Blue</strong> Shield, we are<br />

always looking for new<br />

ways to be "Good for <strong>You</strong>."<br />

Here are some of our<br />

latest accomplishments.<br />

Know <strong>You</strong>r Exposure<br />

To protect our members from overexposure to ionizing<br />

radiation used in medical imaging, Arkansas <strong>Blue</strong><br />

Cross and <strong>Blue</strong> Shield and its family of companies<br />

are including a calculation of a member’s equivalent<br />

dose of radiation from medical procedures in the<br />

new Personal Health Statements. The information,<br />

supplied by National Imaging Associates (NIA), is<br />

based on claims data from health care providers.*<br />

It is important to talk with your doctor about your<br />

medical imaging choices. This additional information<br />

can help you make informed health care decisions.<br />

<strong>You</strong>r doctor can explain the need for a medical imaging<br />

procedure based on the benefits and potential<br />

risks involved.<br />

* Claims data is provided to NIA from Arkansas <strong>Blue</strong> Cross and<br />

<strong>Blue</strong> Shield, Health Advantage and <strong>Blue</strong>Advantage Administrators<br />

of Arkansas at regular intervals. If a claim has not been<br />

filed or was not paid, if the patient has had a lapse in coverage<br />

or if the employer group has opted not to participate, there<br />

may be information on exposure to ionized radiation that is not<br />

factored into this calculation.<br />

New Tools for Small Groups<br />

Effective June 1, Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield and Health Advantage will introduce two new<br />

services for small group (2-50) customers.<br />

eBill Manager is an electronic billing service that<br />

can replace the traditional paper invoice. Only employer<br />

groups that have signed up for <strong>Blue</strong>print for<br />

Employers will be able to access this new service.<br />

eBill Manager will be available to all new groups<br />

sold on or after June 1, and to all renewal groups<br />

on their anniversary date beginning June 1. Electronic<br />

applications for new employees (e-apps) will<br />

be available for all small groups who are registered<br />

for <strong>Blue</strong>print for Employers effective June 1, <strong>2010</strong>,<br />

regardless of their anniversary date.<br />

NIA provides prior authorization services for outpatient diagnostic<br />

imaging services for Arkansas <strong>Blue</strong> Cross, Health Advantage<br />

and <strong>Blue</strong>Advantage. NIA is an independent company that<br />

operates separately from these companies.<br />

<strong>Blue</strong> & <strong>You</strong> <strong>Summer</strong> <strong>2010</strong>

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